ENETS Consensus Guidelines for the Standards of Care in Neuroendocrine Neoplasms: Peptide Receptor Radionuclide Therapy with Radiolabelled Somatostatin Analogues

Hicks, Rodney J.; Kwekkeboom, Dik J.; Krenning, Eric P.; Bodei, Lisa; Grozinsky‐Glasberg, Simona; Arnold, R.; Borbath, Ivan; Ćwikla, Jarosław; Toumpanakis, Christos; Kaltsas, Gregory; Davies, Philippa; Hörsch, Dieter; Janson, Eva Tiensuu; Ramage, John

doi:10.1159/000475526

Cited by 265 publications

(248 citation statements)

References 82 publications

Supporting

Mentioning

241

Contrasting

Unclassified

Order By: Relevance

“…In the present study, we focused on subjects only suffering from NET of pancreatic origin. For NET, treatment options have improved in the last years [35]: The NETTER-1 trial revealed impressive findings using PRRT in midgut NET [8]. Moreover, recent developments of systemic agents such as everolimus or axitinib have also demonstrated favorable results.…”

Section: Discussionmentioning

confidence: 99%

Pre-therapy Somatostatin Receptor-Based Heterogeneity Predicts Overall Survival in Pancreatic Neuroendocrine Tumor Patients Undergoing Peptide Receptor Radionuclide Therapy

et al. 2018

View full text Add to dashboard Cite

Purpose: Early identification of aggressive disease could improve decision support in pancreatic neuroendocrine tumor (pNET) patients prior to peptide receptor radionuclide therapy (PRRT). The prognostic value of intratumoral textural features (TF) determined by baseline somatostatin receptor (SSTR)-positron emission tomography (PET) before PRRT was analyzed. Procedures: Thirty-one patients with G1/G2 pNET were enrolled (G2, n = 23/31). Prior to PRRT with [ 177 Lu]DOTATATE (mean, 3.6 cycles), baseline SSTR-PET computed tomography was performed. By segmentation of 162 (median per patient, 5) metastases, intratumoral TF were computed. The impact of conventional PET parameters (SUV mean/max ), imaging-based TF, and clinical parameters (Ki67, CgA) for prediction of both progression-free survival (PFS) and overall survival (OS) after PRRT were evaluated. Correspondence to: Ralph Bundschuh; e-mail: ralph.bundschuh@ukbonn.deResults: Within a median follow-up of 3.7 years, tumor progression was detected in 21 patients (median, 1.5 years) and 13/31 deceased (median, 1.9 years). In ROC analysis, the TF entropy, reflecting derangement on a voxel-by-voxel level, demonstrated predictive capability for OS (cutoff = 6.7, AUC = 0.71, p = 0.02). Of note, increasing entropy could predict a longer survival (9 6.7, OS = 2.5 years, 17/31), whereas less voxel-based derangement portended inferior outcome (G 6.7, OS = 1.9 years, 14/31). These findings were supported in a G2 subanalysis (9 6.9, OS = 2.8 years, 9/23 vs. G 6.9, OS = 1.9 years, 14/23). Kaplan-Meier analysis revealed a significant distinction between high-and low-risk groups using entropy (n = 31, p G 0.05). For those patients below the ROC-derived threshold, the relative risk of death after PRRT was 2.73 (n = 31, p = 0.04). Ki67 was negatively associated with PFS (p = 0.002); however, SUV mean/max failed in prognostication (n.s.). Conclusions: In contrast to conventional PET parameters, assessment of intratumoral heterogeneity demonstrated superior prognostic performance in pNET patients undergoing PRRT. This novel PET-based strategy of outcome prediction prior to PRRT might be useful for patient risk stratification.

show abstract

Section: Discussionmentioning

confidence: 99%

Pre-therapy Somatostatin Receptor-Based Heterogeneity Predicts Overall Survival in Pancreatic Neuroendocrine Tumor Patients Undergoing Peptide Receptor Radionuclide Therapy

et al. 2018

View full text Add to dashboard Cite

show abstract

“…Of the 21 patients with pretreatment carcinoid syndrome, 90% benefited from therapy. The potential exacerbation of hormonal syndromes leading to crisis after PRRT must be acknowledged, and patients must be carefully selected, prepared, and monitored when treating patients with carcinoid syndrome with this modality [31]. …”

Section: Discussionmentioning

confidence: 99%

Systemic Treatment Options for Carcinoid Syndrome: A Systematic Review

Wolin

Benson

2019

Oncology

View full text Add to dashboard Cite

Background: Carcinoid syndrome symptoms significantly reduce quality of life in patients with neuroendocrine tumors. Evidence supporting the use of somatostatin analogues in carcinoid syndrome symptom control dates back 30 years. The introduction of new treatment options for carcinoid syndrome, such as telotristat ethyl in 2017, highlights the need for a review of high-level evidence of new and established systemic treatments. Objective: To examine the efficacy and safety of systemic treatment options for patients with carcinoid syndrome. Method: A systematic review of English language articles was conducted using PubMed, EMBASE, and the Cochrane Controlled Trials Register using the search terms carcinoid syndrome, clinical trial, clinical study, and prospective study. Additional studies were identified by searching abstracts from oncology or neuroendocrine tumor congresses during the previous year. Prospective, interventional, phase II or III clinical trials or pivotal trials leading to drug approval were included. Studies were required to have >85% of patients with carcinoid syndrome; secondary publications were excluded. Results: The search identified 233 unique records, of which 12 trials met the criteria for inclusion. Interventions assessed in these trials included short-acting and long-acting octreotide, lanreotide prolonged-release and autogel/depot, short-acting and long-acting pasireotide, telotristat ethyl, everolimus, and peptide receptor radionuclide therapy. Somatostatin analogues provided substantial symptom relief for patients with carcinoid syndrome. For refractory symptoms, an increased dose of somatostatin analogue or addition of telotristat ethyl were valuable options. Interventions were generally well tolerated, with few serious treatment-related adverse events. Conclusions: By critically evaluating high-level evidence in a rigorous manner, this review highlights the general lack of consensus regarding what defines symptom control in studies of carcinoid syndrome and the need for standardized treatment guidelines for this disease. More prospective trials of treatments for carcinoid syndrome are warranted to assist oncologists with optimizing treatment selection and sequencing in this patient population.

show abstract

“…Through this trial, 177 Lu-DOTA-octreotate will probably be the first widely approved agent for PRRT. The ENETS Standard of Care for PRRT clearly describes evidence, treatment protocols, and patient selection for treatment with PRRT [64]. …”

Section: Systemic Therapymentioning

confidence: 99%

The Evolution of Neuroendocrine Tumor Treatment Reflected by ENETS Guidelines

Zandee

Herder²

2018

Neuroendocrinology

View full text Add to dashboard Cite

In 2016, the third version of guidelines for the diagnosis and treatment of neuroendocrine tumors (NETs) has been published by the European Neuroendocrine Tumor Society (ENETS). These guidelines reflect the progress in treatment of NETs, and by comparing the newest guidelines with the first guidelines of 2001, this progress can be clearly recognized. Diagnostic accuracy has been increased by the introduction of PET-CT with Ga-labelled somatostatin analogs, and multiple new treatments and treatment schedules have been developed, like peptide receptor radiotherapy with radiolabeled somatostatin analogs, or targeted therapies. Evidence and indications for these therapies are discussed in the ENETS guidelines. In this review, we aim to show the progress in NET diagnosis and treatment on the basis of the advances in the guidelines, but also to discuss the unsolved questions and unmet needs which still remain.

show abstract

ENETS Consensus Guidelines for the Standards of Care in Neuroendocrine Neoplasms: Peptide Receptor Radionuclide Therapy with Radiolabelled Somatostatin Analogues

Cited by 265 publications

References 82 publications

Pre-therapy Somatostatin Receptor-Based Heterogeneity Predicts Overall Survival in Pancreatic Neuroendocrine Tumor Patients Undergoing Peptide Receptor Radionuclide Therapy

Pre-therapy Somatostatin Receptor-Based Heterogeneity Predicts Overall Survival in Pancreatic Neuroendocrine Tumor Patients Undergoing Peptide Receptor Radionuclide Therapy

Systemic Treatment Options for Carcinoid Syndrome: A Systematic Review

The Evolution of Neuroendocrine Tumor Treatment Reflected by ENETS Guidelines

Contact Info

Product

Resources

About